Changes in the clinical measurement of visual acuity

In 1862, Hermann Snellen introduced his letter chart for the clinical measurement of visual acuity. His chart presented letters,or optotypes, arranged in a progressively diminishing size sequence, and the visual acuity was determined by the smallest letters that could read at a specified distance. Numerous modifications of the design of the optotypes, the progression of size and the chart layout were suggested, and in 1976, Bailey and Lovie published a set of design principles that made the visual task the same at all size levels, so that size become the only significant variable. This required the same number of letters at each size level, fixed spacing ratios and a logarithmic progression of size. This facilitates more precise quantification of visual acuity by giving credit for every letter read correctly, and this gives clinicians tighter confidence limits for determining changes or differences in visual acuity. However, optotype choices, and associated spacing arrangements can have significant effects on visual acuity scores as can viewing conditions and testing protocols. Computer based visual acuity tests are becoming more commonplace, there will be more variety in test charts and procedures which will create some problems for making comparisons between tests.